POS1180 AUTOIMMUNE SYNDROMES WITH CHRONIC HEPATITIS C VIRUS INFECTION AND DIRECT-ACTING ANTIVIRAL TREATMENT.
Authors: R. H A Mohammed, D. Hassan Attia, M. Abdelazeem, A. Elsayed Taha, D. Rasheed Bahgat, H. Ibrahim I Elmakhzangy
Journal: Annals of the Rheumatic Diseases (2022)

Background Chronic hepatitis C virus (HCV) infection is a multifaceted disease that has been associated with systemic as well as organ-specific, autoimmune manifestations with increasing virologic, and clinical evidence supporting the association. The development of direct-acting antivirals (DAAs) is considered an advent that might aid the clearance of extrahepatic immune manifestations of HCV. 1,2,3 Objectives Investigate the effect of directly acting antiviral drugs (DAA) on the different autoimmune manifestation and serologic changes associating chronic HCV infection. Methods Inclusion criteria: This is a cohort study that included adult patients aged ≥18 years, of either sex, having CHCV with detectable HCV ribonucleic acids (RNA) by Polymerase Chain Reaction (PCR) and eligible for the DAAs treatment. Exclusion criteria: Patients with established rheumatological disease prior to the onset of HCV diagnosis. Patients with decompensated cirrhosis. Patients with platelet count less than 50000/ mm 3 .Patients with HCC (except after 6 months of curative intervention). All patients were subjected to full history taking, clinical and laboratory investigations. Results The study enrolled 130 chronic HCV patient (90 patients completed follow up). 66.7 % females and 33.3% males (ratio 2:1), the mean age was 49.2±12.3 years. The study found 77/ 90 (85.55%) patients to have immune mediated manifestations and associated serological changes prior to DAA. The most prevalent were musculoskeletal manifestations in 56 patients (72.7%), arthralgia (66.2%), fatigue (54.5%) and myalgia (50.6%), xerophthalmia (24.7%), neuritis (28.6%) (P-value &gt; 0.01), and a positive RF in 33.8% (P-value 0.013). HCV Among patients who achieved sustained viral response, autoimmune manifestations persisted in 66 out of 71 patients (92.9%) who were positive at baseline. The most prevalent autoimmune manifestations after therapy were musculoskeletal manifestations 53 patients (68.8%). Responders with persistent autoimmune manifestations had an observable rise in inflammatory biomarkers posttreatment erythrocyte sedimentation rate was (46.22±19.62) became (56.05±25.45),C reactive protein titer was (8.46±12.76) became (20.01±25.92), P &gt;0.01. Predictors for persistence of autoimmune manifestation were older age ≥ 49 years P-value 0.009, female sex P= 0.026, tobacco consumers P= 0.043. Conclusion The introduction of directly acting antiviral drugs wasn’t associated with a significant change in the prevalence of autoimmune manifestations in our population of Egyptian patients with chronic HCV who attained a sustained viral response. References [1]Negro F. Natural History of Hepatic and Extrahepatic Hepatitis C Virus Diseases and Impact of Interferon-Free HCV Therapy. Cold Spring Harb Perspect Med. 2020 Apr 1;10(4):a036921. [2]Polo ML, Laufer N. Extrahepatic manifestations of HCV: the role of direct acting antivirals. Expert Rev Anti Infect Ther. 2017 Aug;15(8):737-746. doi: 10.1080/14787210.2017.1354697. Epub 2017 Jul 17. PMID: 28696154. [3]Degasperi E, Aghemo A, Colombo M. Treatment of Extrahepatic Manifestations of Hepatitis C Virus. Clin Liver Dis. 2017 Aug;21(3):631-643. doi: 10.1016/j.cld.2017.03.015. PMID: 28689598. Disclosure of Interests None declared